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Results for “Intestinal Fistula”

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PubMed1986

[Roentgen diagnosis of inflammatory bowel diseases in the child].

Inflammatory diseases of the bowel, especially of the small bowel, frequently present with vague symptoms in children. In many cases X-ray examination enables diagnosis, differentiation and localization of such diseases, as well as follow up and detection of complications. In the hand of the experienced radiologist the exposure to X-rays is very low. Radiological signs are demonstrated according to the most important inflammatory disease entities.

Child↗
PubMed1986

[Reconstruction of the cervical esophagus by the free transfer of a jejunal loop. An experimental study in dogs].

A study was performed in twenty dogs in order to evaluate the chronic effects of free jejunal transfer and possible subsequent radiation therapy. Ten dogs were sacrificed within one week after surgery, three survived twelve to twenty days, and seven survived longer than six weeks with only one completing a full course of radiation equivalent to 6,000 rads to the jejunal flap. Fistulization was the most frequent complication in short-term and intermediate survivors. Inanition due to a functional rather than anatomic stenosis and dysmotility was observed in the long-term survivors. Interval oesophagoscopy and biopsy was of no additional value in evaluating flap survival. The jejunum of the animal receiving radiation showed a greater submucosal inflammatory response when compared to the other animals. Attempts at intraoperative cooling of the jejunal segment did not increase bowel survival or diminish the rate of fistulization.

Animals↗
PubMed1986

Surgery for recurrent intra-abdominal cancer.

A review of 185 patients who developed recurrent intra-abdominal cancer has been undertaken to compare the results after emergency (41 patients) and elective (144 patients) surgery. The overall postoperative mortality was 19% and morbidity 45%. The mean survival was 13 +/- 20 months, median 7 months and cumulative 5-year survival 5%. The postoperative relief of symptoms was 7 +/- 18 months. A statistically significantly poorer prognosis was observed in emergency patients when compared with those operated on electively. Postoperative mortality and morbidity rates after emergency operations were 41% and 68% and after elective surgery 13% and 39%. The mean survival in the emergency group, 5 +/- 10 months, was significantly shorter than in the elective group, 17 +/- 22 months. The postoperative relief of symptoms for emergency patients was 2 +/- 3 months and for elective patients 10 +/- 22 months. Postoperative sepsis was the most common complication in the emergency group and it caused death in 9 of the 10 cases. Formation of intestinal fistula and early obstruction were the most frequent complications in the elective group. Emergency resections and bypass procedures carried the lowest risk of mortality, 33% and 11%, when compared with enterostomy and laparotomy, which were accompanied by a mortality of 61% and 50%. It is concluded that resective surgery has the best chance to improve survival in emergency surgery for recurrent cancer, although it is associated with a high risk of morbidity and mortality and a disappointingly short relief of symptoms. If resection is not feasible, the possibility of creating a bypass should be considered.

Abdominal Neoplasms↗
PubMed1985

[Large-intestinal lesions in destructive pancreatitis].

An acute destructive pancreatitis may be followed by a lesion of the colon with its developing necrosis, narrowing etc. Seven cases with such complications are described. Problems of surgical tactics in patients with a destructive pancreatitis complicated by lesions of the colon are discussed.

Acute Disease↗
PubMed1985

Pathology of the ageing--diverticular disease.

The correlation of increased incidence of diverticular disease with age is well documented. Such a correlation results from the development of a structural change in the taeniae coli, a progressive elastosis. The consequences of this elastosis are a shortening of the taeniae coli and a subsequent change in the circular muscle layer secondary to this. This type of structural alteration takes time to develop and thus explains the time lag experienced between a change in diet and an altered incidence of the disease. Eastwood et al (1982) have suggested that diverticular disease is merely a normal concomitant of ageing which is degenerative in nature. However, the changes in structure in this condition appear to be dynamic, being associated with an altered intraluminal environment. Such a concept is crucial to our understanding of the pathology of ageing in general. Atherogenesis is associated with muscle cell hypertrophy, another dynamic change, which also leads to elastin formation. This suggests that treatment of such conditions should not just be limited to the control of an inevitable deterioration but should be directed to the investigation of the stimuli that may trigger such conditions. For example, it is interesting to speculate exactly when the changes that lead to diverticular disease begin: not only is a high fibre diet eaten in Africa, but breast-feeding may continue until the age of two years. The greatest increase in thickness in the normal colon occurs in this period and it may be that early weaning distorts this proliferation. The initiating factor in the aetiology of elastogenesis could be the small stools produced on a 'Western' diet which only intermittently distend the colon. Arterial smooth muscle cells increase their uptake of elastin precursors (particularly proline) when subjected to intermittent distension (Leung et al, 1976) and this may form a common link in the changes generated in vascular and colonic muscle tissue with time. This type of change is independent of alterations in motility and thus explains why asymptomatic patients have a normal motility index (Weinreich and Anderson, 1976). The muscular thickening in uncomplicated diverticular disease can therefore be explained in terms of elastosis and contracture of the taeniae coli in the presence of normal muscle cells. This does not exclude the possibility that hypertrophy and hyperplasia of these cells can develop in response to subsequent pericolic inflammation and fibrosis.

Age Factors↗
PubMed1985

[Relaparotomy in children].

124 relaparotomies were performed in 70 children (1,9% of all the patients who had been operated on organs of the abdominal cavity). Eventrations made their appearance mainly in children of the first year of life, operated upon for malformations and having severe background diseases. The transrectal incision was found to have no advantages over the median incision in relation to the appearance of eventrations. Lethality after relaparotomied was 36,6%.

Child↗
PubMed1977

The importance of nutritional support for the geriatric surgical patient.

An appropriately designed program of nutritional support will allow the geriatric patient to undergo necessary surgical therapy with fewer risks and improved results. The selection of the route of administration and the specific agent(s) will depend on the functional status of the gastrointestinal tract as well as the patient's protein and calorie requirements. Table 6 summarizes our recommendations in the delection process. Our obvious preference is the gastrointestinal tract route if possible. When this optimum method of nutritional management is not available, sequential or concurrent supplemented feedings or intravenous hyperalimentation may be required to achieve adequate protein calorie intake. Regardless of the route chosen, careful monitoring of the geriatric patient's response to nutritional therapy is required. Only through careful planning and execution of nutritional therapy can optimum results be achieved in this group of patients.

Age Factors↗
PubMed1985

[180 aorto-bifemoral bypasses for chronic occlusive arteritis].

In the authors' experience, 180 aorto-bifemoral by-pass grafts represent 42.4% of all reconstructive operations for aorto-iliac atheromatous disease performed between 1st January 1972 and 1st July 1983. 37% of the patients presented a threatened amputation and 38.8% had a walking distance of less than 100 metres. The immediate post-operative mortality (1st month) was 2.2% (4 patients). The 5 year survival, expressed according to the actuarial method, was 89% and the patency was 91%. The long-term functional deterioration was due to a progressive alteration of the distal vascular bed and to complications: false aneurysms (2.2%), prosthetic infections (1%), aorto-intestinal fistulae (2.2%), thrombosed prostheses (7.3%). 7 complementary femoro-popliteal by-pass grafts (4%) and 13 major amputations (7.4%) were required. The authors stress the value of performing end-to-end aortic anastomoses rather than side-to-end anastomoses. The anastomoses should be well isolated from the gastrointestinal tract. The patients should be rigorously followed post-operatively and any complication detected should be treated actively.

Aged↗
PubMed1977

Hyperalimentation.

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Acute Kidney Injury↗